ERCP is a procedure that allows the physician to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. The procedure combines x-rays and the use of an endoscope. The scope is guided through the patient's mouth and throat, then through the esophagus, stomach, and duodenum. The physician can examine the inside of these organs and detect any abnormalities. A tube is then passed through the scope, and a dye is injected which will allow the internal organs to appear on an x-ray.
If a duct is blocked, the physician can open it up by inserting a tiny stent (slender tube) into the duct through the endoscope, which can remain in place to keep the duct open. The physician may also take a small biopsy of tissue.
Before having ERCP, patients fast for 12 hours. They receive a sedative and anesthesia, before undergoing ERCP. The procedure itself requires about an hour.
Advanced applications of ERCP that are performed at the Center for Advanced Digestive Disease include:
Endoscopic ultrasound (EUS)-assisted ERCP: This approach combines two endoscopic procedures to perform interventional treatments, such as clearing of a blockage in a bile duct. First, an "echoendoscope" is inserted into the patient's mouth and throat, which uses high-energy sound waves to locate the obstruction and the opening of the bile duct. Then ERCP is used to place a metal or plastic stent to open the obstruction.
EUS-guided ERCP is also useful when there are either anatomic abnormalities that don't make it possible to use standard ERCP, such as intestinal pouches near the union of the pancreatic and common bile ducts, or when the intestines have been redirected after surgery (which often happens after weight loss surgery, peptic ulcer surgery, and certain other gastrointestinal operations). In addition, sometimes conventional ERCP is difficult or impossible to perform when a tumor is completely obstructing the bile duct or its entrance.
Single-balloon ERCP: This imaging procedure uses endoscopy to visualize inside the small intestine and balloons that are inflated. When inflated, the balloons cling to sections of the small intestine and pleat it over the endoscope, effectively "shortening" it. Shortening of the small intestine over the endoscope lets the doctor undertake a comprehensive examination of the entire small intestine and makes biopsies, injections, and other treatments in the small intestine possible, including ERCP without surgery.